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Anger and aggression treatments: a review of meta-analyses
Amy Hyoeun Lee and Raymond DiGiuseppe
In the last several decades, researchers have begun to Most mandates for anger management assume that a
recognize dysregulated anger as a common and debilitating direct relationship exists between anger and aggression,
psychological problem among various psychiatric populations. and that targeting anger would reduce or eliminate the
Accordingly, the treatment of anger and aggression has aggression. While the number of studies on this relation-
received increasing attention in the literature. The current ship is remarkably small [1], the limited literature sug-
article reviews existing meta-analyses of psychosocial gests that anger does not always lead to aggression, nor is
intervention for anger and aggression with the aims of (1) anger a necessary cause of aggression. A recent meta-
synthesizing current research evidence for these interventions, analytic review, however, found a robust relationship
and (2) identifying interventions characteristics associated with between anger and violent behavior [2], and a recent
effectiveness in specific populations of interest. Results evaluation of an individually-delivered anger treatment
demonstrate that cognitive behavioral treatments are the most found that reductions in aggressive behaviors were asso-
commonly disseminated intervention for both anger and ciated with decreases in anger [30]. This emerging liter-
aggression. Anger treatments have consistently demonstrated ature provides support to the supposition that treatment
at least moderate effectiveness among both non-clinical and of anger will result in reduction of aggression. However,
psychiatric populations, whereas aggression treatment results some anger management interventions have failed to
have been less consistent. We discuss the implication of these produce positive effects in prison samples [3]. Given
findings and provide directions for future research in the the context in which most people are referred or man-
treatment of anger and aggression. dated to such interventions, both anger and aggression
serve as related yet distinct outcomes of interest.
Address We reviewed the literature on anger and aggression inter-
Department of Psychology, St. John’s University, 8000 Utopia Pkwy, ventions to shed light on the effectiveness of anger man-
Queens, NY 11439, United States agement programs. Not long ago, the amount of literature
Corresponding author: DiGiuseppe, Raymond (digiuser@stjohns.edu) on this topic was thin. However, in preparation for this
review, we uncovered a large number of studies. As review-
ing them all would be beyond the length of this article, we
Current Opinion in Psychology 2017, 19:65–74 focused our attention on meta-analytic reviews of anger and
This review comes from a themed issue on Aggression and violence aggression treatments. A literature search revealed 21 such
Edited by Brad J Bushman meta-analyses, most of which focused on specific popula-
tions. These meta-analyses represent a substantial data-
base from which to assess whether such treatments work
and which treatments appear to be most successful.
http://dx.doi.org/10.1016/j.copsyc.2017.04.004 Methods
2352-250X/ã 2017 Elsevier Ltd. All rights reserved. Search strategy and study selection
We searched PsycINFO and PubMed for meta-analytic
reviews published between the earliest available year
and February 23, 2017. We used the keywords ‘anger’ or
‘aggression’ AND ‘treatment’ or ‘therapy’ AND ‘meta-
analy*’ in the title. Our search yielded 76 articles published
Introduction between 1998 and January 2017, and 75 articles published
The phrase anger management has become commonplace between 1992 and 2016 from PsycINFO and PubMed,
in the Western culture. In the U.S., the term has been respectively. After removing duplicates, we inspected the
used in the media and was the title of a 2003 movie and a remaining articles for meta-analytic reviews of non-psycho-
television series. A recent Google search resulted in pharmacological treatments targeting primarily anger or
approximately 30 000 web pages (February 27, 2017). aggression. We identified 13 meta-analyses of treatments
arrested for assault or domestic violence in the targeting anger and 8 meta-analyses of treatments targeting
Those
U.S. and other countries are frequently referred for anger aggression, which are included in this review.
management classes as a condition of their release, plea,
or probation. Given the widespread use of anger manage- Results
ment and the mandate for such treatments in legal Treatments targeting anger
systems, knowledge about the effectiveness of these Table 1 summarizes the results of the 13 meta-analyses
interventions is much needed. on treatments of anger.
www.sciencedirect.com Current Opinion in Psychology 2018, 19:65–74
Current Table 1 66
Characteristics of meta-analyses of treatments targeting anger (in chronological order) Aggressi
Opinion Study Years of No. of No. of Sample Treatment Treatment Treatment Outcome Effect size(s)
publication studies (k) participants characteristics type(s) setting/modality components variable(s)
on
(N)
in
and
Psychol Henwood Prior to June 14 3226 Adult male CBT-based Prison or Self-management, General and violent .77 overall, .72 for violent
et al. [4] 2014 offenders anger community/Group challenging recidivism recidivism violence
treatments dysfunctional thinking,
ogy and relapse
prevention; arousal
2018, and anger control
training and moral
19 reasoning; arousal
:65–74 reduction,
communication skills,
relationships,
addressing cognitive
distortions, and
problem solving
Hamelin 2002–2005 8 336 Adults with CBT Not reported/ Discussion of causes, Anger 1.52overall for RCTs
et al. [5
] intellectual Individual and group appropriate (unweighted); .89 within-
disabilities expression of anger, group for pretest-
cognitive posttest (unweighted)
restructuring, role
play, relaxation and
problem solving
Nicoll 1999–2011 9 302 Adults with Treatments with Community, Psychoeducation, Anger .88 overall; .84 for group
et al. [6] intellectual cognitive institutional/Most self-monitoring, treatments, 1.01 for
disabilities behavioral delivered in groups cognitive individual
framework restructuring,
relaxation, self-
instruction, role-play
and problem solving
Kusmierska* Prior to 2010 17 Not Varied CBT combined Not reported/ CBT: Relaxation, Anger .58 overall
[7] reported (37 studies) or Individual and group exposure, cognitive
Novaco’s restructuring, social
multicomponent skills, systematic
anger treatment desensitization,
model problem solving, self-
(19 studies); instruction training,
non-CBT and education. Non
(16 studies) CBT: meditation,
www.sci forgiveness, use of
humor, acceptance
and commitment
encedirect.com therapy (ACT), the
process group
www.scien Table 1 (Continued)
Study Years of No. of No. of Sample Treatment Treatment Treatment Outcome Effect size(s)
publication studies (k) participants characteristics type(s) setting/modality components variable(s)
cedirect.com (N)
Ho et al. [8] 1982–2007 18 408 Children with Cognitive Schools and research Direct cognition Three dimensions of .61 overall; .34 for
special needs behavioral clinics/ Individual and treatments, affect anger: behavior, behavior, .63 for
(Ages 8–18) approach group education, stress cognition, affect cognition, .82 for affect,
inoculation, external .19 for anger control skills
trigger recognition,
anger arousal
recognition, problem-
solving skills, self-
instructions,
assertiveness,
relaxation techniques,
specific coping
strategies
Candelaria 1979–2010 60 3386 Children Anger Schools/ Groups Coping skills training, Overall behavioral/ .27 overall; .29 for Anger
et al. [9 ] (Ages 5–18) management emotional awareness emotional index, conduct problem/
interventions for and self-control, conduct/ delinquency, delinquency, 1.28 for
school-age problem solving CBT, knowledge of anger knowledge of anger and
children relaxation techniques, management management principles,
role play or modeling principles, blood .33 for anger, .34 for aggression
activities pressure, anger, aggression
aggression, self-
control,
forgiveness, social
skills treatmen
Saini [10] Prior to 2009 96 7440 Adults (college Cognitive, CBT, Varied/ Majority were Not reported Anger constructs .76 overall; 1.40 for
students, health exposure, group (general, control, psychodynamic, .67 for
care patients, psycho- person specific, relaxation, .60 for CBT, ts:
incarcerated dynamic, expression, state, .83 for CT a
offenders, psycho- trait, driving) review
mental health educational,
Current clients) relaxation-
based, skills- of
based, stress meta-anal
inoculation
Opinion Gansle [11] 1984–2003 20 Not reported Children & School based Schools/ Majority Discussion, role play, Externalizing and .31 overall; .53 for follow
adolescents anger delivered in groups practice, modeling, anger, internalizing, updata;.54forangerand
(Ages 5–18) interventions homework, reward for social skills, and externalizing, .43 for yses
in
compliance, academics; beliefs internalizing .34 for social
Psychol
performance and attitudes skills Lee
feedback, reward for
ogy performance, and
conducting parent or
DiGiuseppe
2018, teacher group
sessions, goal setting,
visualization/imagery,
19
:65–74 contracting, academic
tutoring, games, and
home visits 67
Table 1 (Continued)
Current Study Years of No. of No. of Sample Treatment Treatment Treatment Outcome Effect size(s) 68
publication studies (k) participants characteristics type(s) setting/modality components variable(s) Aggressi
(N)
Opinion Sukhodolsky 1968–1997 40 1953 Children & CBT for anger- Majority deliver in Instruction, Physical aggression, .67 overall; .79 for skills
et al. [12] adolescents related schools/ Majority discussion, modeling, anger experience, development and .74 for on
(Ages 6–18) problems delivered in groups role-play, feedback, self-control, social eclectic treatments,
in
and
Psychol emotion identification, problem-solving, and .36 for affective
relaxation, self- social skills education, .67 for
instruction, exposure, problem solving violence
ogy homework, and treatments
reinforcement
2018, DiGiuseppe 1970–1998 50 230 Adults Any treatments Not reported/ Self-instructional Overall, anger, .71 overall; 1.16 for
and Tafrate targeting anger Individual and group training, cognitive aggression, individual, .68 for group
19 [13] restructuring, problem positive behaviors,
:65–74 solving, relaxation, other emotions,
systematic physiological arousal,
desensitization, attitudes/ cognition,
exposure, behavioral Type A, Self-esteem
skills training,
combined
interventions, anger
management training
experiential group
process based on
Yolom’s (1995) group
treatment, humor,
education, meditation,
and biofeedback.
Del Vecchio Jan 1980– 23 1340 Adult CBT, cognitive Setting not reported/ To be considered a Anger (control, .68 for CBT; .82 for CT;
and August 2002 outpatients (CT), relaxation Majority delivered in CBT,thetherapy must suppression, .90 for RT; .61 for Other
O’Leary definedasangry (RT), and other groups contain both expression, driving,
[14] by pretreatment (O) behavioral and state, trait)
anger scores cognitive components;
relaxation refers to
treatmentsthatprovide
onlyrelaxationtraining;
treatments that could
not be placed in any of
these categories were
evaluatedtogetherand
entered into “other’’
Beck and 1970–1995 50 1640 Adults and CBT treatments Not reported Identifying situational Self-reported anger .70 overall
Fernandez children; “triggers”, cognitive behavioral ratings of
www.sci [15] predominantly self-statements, anger/ aggression
clinical acquisition of
relaxation skills,
encedirect.com problem-solving
conflict management
and social skills
training
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